The long-term objective of this project is to advance our understanding of non-pharmacologic control of pain from severe burn injuries and other etiologies by applying state-of-the-art advances in virtual reality (VR) technology as a psychologically based treatment. This proposal is for a competitive renewal of an NIH R01 level grant and will represent the fifth cycle of funding (the current cycle of funding ended June 30th, 2007). Two studies are proposed. First, we propose to expand our largely pre-clinical research with VR analgesia to a multi-site pediatric, culturally diverse patient population, using clinically relevant interventions in the first randomized controlled study of this nature. In Study 1, we will determine whether reducing clinical, post-burn pain during physical therapy (using VR analgesia) leads to long-term improvements in pain and adjustment outcomes. Further, we will examine whether a highly immersive VR system (i.e., a highly captivating VR virtual environment) reduces pain and long-term outcome more effectively than a less immersive VR system. We will also study individual differences in patients that might help explain why some patients show more or less VR analgesia than others. Study 2 is an experimental study (analog electrical pain) that will contribute to our theoretical understanding of the potential mechanism(s) (e.g., attention/distraction) underlying VR analgesia. In this study we will explore for the first time whether there is a relationship between how much attention an individual devotes to VR (as measured by a conventional auditory divided attention task) and the magnitude of analgesia produced by VR. If Study 1 hypotheses are supported, this will implicate an attentional mechanism for VR analgesia. The proposed project is significant in that it seeks to test the efficacy of interventions to increase pain control and decrease stress in a trauma population and better understand the mechanism of attention, and patient variables associated with these interventions. The innovative techniques proposed should be applicable to patients suffering pain from several etiologies. PUBLIC HEALTH RELEVANCE: The pain from severe burn injuries is usually excruciating and difficult to control. Strong opioid pain medication cannot alleviate all burn pain, and can have a number of adverse side effects;adjunctive interventions with no side effects are highly desirable. The proposed project will be a multi-site, randomized project conducted between the University of Washington and the Shriners Hospital for Children at Galveston to investigate the short and long-term impact of immersive virtual reality on repeated physical therapy sessions conducted on children with large burn injuries. The findings from both this clinical trial and a proposed experimental study to understand the mechanisms of virtual reality pain control should have implications for managing pain from a variety of sources.